Telemedicine On the Rise During COVID-19 Pandemic

Prior to COVID-19 there had been some concerns about the feasibility of wider use of telemedicine, but people have had to take a leap, Dr. Megan Mahoney, chief of staff at Stanford Health Care and Clinical Professor in the Division of Primary Care and Population Health at Stanford University, told MedTruth.

“A lot of us have gotten over that hump and now we all can appreciate the vast benefits of having it as another option – not replacing in-person care – but as another way to provide care when appropriate,” Mahoney, also a practicing internal medicine physician at Stanford, said.

So what counts as appropriate? Where does telemedicine fall short? Here’s what to know before trying it.

What is Telemedicine?

Telemedicine refers to the remote delivery of clinical health care services. It’s a type of “telehealth,” which also includes things like public health efforts and health education that include technology.

General medical direct-to-consumer apps such as Teladoc and Doctor on Demand connect patients with clinicians for a wide-range of virtual appointments, usually with much more availability than your personal doctor. Niche apps like PRJKT RUBY and Hims specialize in more limited, particular products and services such as birth control, erectile dysfunction drugs, or home testing kits that can be sent to patients after patient information is reviewed by a physician.

Virtual visits with established health care providers have been around in some settings for awhile. However, before the pandemic, insurers and publicly-funded payers like Medicare had tighter rules around what types of telemedicine services they would reimburse for, which limited the use of telemedicine. Under the current expanded guidelines, providers can also offer patient care via telephone, secure telemedicine platforms, and other video conferencing tools such as Zoom.

Those expanded guidelines are what has enabled Boston-based freelance writer Hannah Bernstein, 22, the continuity of online sessions with the same psychologist she’d been seeing in person for several years. 

“It’s nice to be in my own bed, able to chat with my therapist in my own space, and a space I feel comfortable in,” she told MedTruth.

But it’s far from perfect. Bernstein and her therapist occasionally talk over one another. And Bernstein has multiple roommates. 

“My apartment has thin walls,” she said. “It still feels weird to be talking about mental health topics in my apartment filled with people.”

Regardless, Bernstein said she would absolutely do it again. With telemedicine, the appointments were much easier to fit into her schedule. 

She also recently saw an allergist via telemedicine as well. The appointment took less than 20 minutes and the doctor prescribed the medications Bernstein needed. 

When Does Telemedicine Make Sense? When to Seek In-Person Care?

The appropriateness of telemedicine depends on a lot of factors, Dr. Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center, told MedTruth. Mehrotra researches innovations in health care delivery, including telemedicine models.

Mehrotra likens “telemedicine” to “prescription drugs.” You wouldn’t make a blanket statement that they’re all good or bad – most prescription drugs have big benefits when used at the right time for the right reason, he said.

For telemedicine visits with your regular doctor with whom you have an established relationship, the obvious benefit is reducing coronavirus exposure by moving care to the safety of online interaction, Mehrotra said. 

To determine if a telemedicine app is safe for you, think about what type of patient you are and what you’re using the app for. If you’re young, generally healthy, and have a seemingly straightforward medical question or issue to take care, the care you get on an app might be wholly sufficient, Mehrotra said. 

If you’re taking several medications or have underlying conditions that might complicate how other issues are addressed, you probably want to seek care from a doctor who’s more familiar with medical history, Mehrotra said.

When medically appropriate, telemedicine can potentially work well for relatively straightforward care that doesn’t require an in-person exam, Mahoney said, such as: 

• Check ups for managing chronic conditions like diabetes, hypertension, heart disease, and COPD
• Diagnosing acute conditions like urinary tract infections with straightforward symptoms (e.g. burning urination), colds, gastrointestinal problems such as heartburn, and skin conditions
• Post-surgery follow up
• Prescription refills
• Some mental health care
• Telemonitoring of vital signs from scales, blood pressure cuffs, and glucometers that are automatically added to patient records via tracking apps and programs

Telemedicine apps can also be useful for obtaining second opinions, when care is straightforward and there’s some form of time pressure, and in the current health crisis to determine who needs in-person care versus what issues can be addressed virtually, Dr. Mia Finkelston, medical director for Amwell telemedicine app, told MedTruth. 

On the other hand, you can’t perform lab tests via telemedicine, you can’t fix a broken bone, and it’s not appropriate for medical emergencies, Finkelston said. 

And an app cannot be a substitute for a doctor with whom you have an established relationship, who knows your medical history, and can take a comprehensive look at your health when making a diagnosis or care recommendation, Dr. Gary LeRoy, Dayton, Ohio-based family physician and president of the American Academy of Family Physicians. 

“There are a lot of intangibles that your (primary care provider) brings to your care that can’t be replaced with an app,” LeRoy told MedTruth. For instance, doctors are trained in medical school to catch potentially serious diagnoses first, before landing on whatever the problem most likely is. It’s unclear if apps can replicate that, he said.

LeRoy recommends talking with your doctor about telemedicine services you’re considering trying to help decide what’s appropriate or not. And remember that your doctor’s office probably has a physician “on call” to address urgent needs after hours and on weekends, too, he said.

If you do use a direct-to-consumer app to get medical care: Share that information with your primary care provider. Some apps send you a summary “visit” report, but you still need to send it to your doctor’s office or bring it to your next appointment, Mehrotra said.

Is My Health Information Secure with Telemedicine?

Before the COVID-19 pandemic, federal law required that health care rendered virtually needed to use encrypted software compliant with the U.S. Health Insurance Portability and Accountability Act of 1996, also known as HIPAA. That regulation covered telemedicine services via your doctor or a direct-to-consumer app.

Currently that regulation is not being enforced to allow providers to quickly move to telehealth. That’s why, at least for now, some providers are able to do visits via video conferencing tools such as Zoom, which may not be as secure as HIPPA-compliant platforms (though Zoom, for example, has rolled out a more secure version of its platform designed for telemedicine). Mehrotra advised patients to contact their providers with any concerns about the provider’s telemedicine platform.

It’s worth noting that newer niche apps such as PRJKT RUBY and Hims may not be subject to certain federal consumer protection regulations, such as those prohibiting the marketing of off-label drug use directly to patients, according to a 2019 editorial co-written by Mehrotra.

Is Telemedicine More Affordable?

The short answer is, it depends. 

Insurance policies vary widely. Your out-of-pocket costs may vary depending on whether or not you’ve met your deductible, any special waivers your insurer has enacted because of COVID-19, or whether you connect with your doctor via phone or video.

If time and health status allow, be sure to review the details of your policy and contact your insurer with any questions or concerns, as insurance policies are often notoriously difficult for consumers to decipher.

When it comes to direct-to-consumer apps, some do take insurance – and some insurance plans provide coverage for specific telemedicine app(s). Other apps charge a flat fee per service, which can sometimes be significantly less than in-person care charges according to a 2017 study.